This is part two of a two-part series looking at Certified Nursing Assistants on Cape Cod, and how this workforce shortage impacts the region. Read part one here.

Nursing homes across the Cape and Islands are facing dire staffing shortages, particularly for Certified Nursing Assistants, also known as "CNAs." These workers are considered the backbone of a nursing home's staff, caring directly for residents. Now one startup company, based in Quincy, is trying to alleviate the problem by making filling a certified nursing position like calling an Uber.

Chris Caulfield is co-founder of an app called IntelyCare. A former nursing home scheduler and a hospital IT manager, Caulfield said he got the idea for the app after seeing the strain of nursing home staffing. When nurses cancelled last minute, other full-time staff would have to work overtime to fill in.

"I saw my fellow colleagues being mandated to stay extra shifts, and they were suffering from taking shifts that didn't have enough staff to take care of residents," Caulfield said.

He added that IntelyCare isn't meant to be a replacement for nursing assistants hired in-house, and that he doesn’t think it’s a good idea for nursing homes to be staffed entirely by IntelyCare. But the app can be the bridge between an understaffed and a well-staffed nursing home.

"You can't staff a whole facility with 100 percent [IntelyCare nurses]. It just wouldn't work, it would be dangerous," Caulfield said. "But the balance of 5 percent or 10 percent to make sure your own staff isn't being turned over or burnt out, and to make sure you're delivering care, is extremely important."

IntelyCare essentially allows users to pick up extra nursing shifts, much like Uber or Lyft drivers. Nursing homes post the shifts they need workers to fill. Nurses can view all available shifts within a certain area and pick up whatever times work for their schedule.

There's also surge pricing. And because the rates are set through IntelyCare and not through individual homes, hourly rates are typically higher than what an in-house nursing assistant would be paid: $15-to-$18 an hour, rather than minimum wage.

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The IntelyCare app lets users see what shifts are available in an area, and how much each shift will pay per hour.
Sarah Mizes-Tan WCAI

One of the app users, Rebecca Besse, has been working as a full-time nursing assistant for 15 years. She still works as an in-house nursing assistant at a home in Wareham, and uses IntelyCare to pick up extra shifts on her days off, partially because the pay is higher. She pointed out a shift that was currently going for $20 an hour because it was a weekend shift.

But the need for certified nursing assistants in the region is so bad that sometimes, there just isn’t in-house nursing staff to fill every shift, even if full-time employees don't cancel. Besse said there have been a couple times where she's gone to work an IntelyCare shift at a facility and she realized that almost all the other nursing assistants were there through IntelyCare also.

"One of the places I worked, you pretty much worked with Intelygroup, and one main CNA if you're lucky," she said. "That does make it hard because you're walking in knowing none of the residents. Granted, most of the care is the same, but you need to know how to approach the resident, how to handle some of their outbursts and such."

There are six nursing homes currently signed up to use IntelyCare on the Cape, and about 400 nursing assistants who use it in the region. She doesn’t know what would fix the workforce shortage, but she does think better pay could help.

"The industry itself is a tough one. I mean, you're walking through the door, you're not knowing what you're walking into," Besse said. "Some people say more money [would help]. My sister-in-law works at [Cumberland Farms] and makes more money than I do."

And the severe workforce shortage means nursing homes on Cape Cod are at a higher risk of closing. State senator Julian Cyr has been spearheading a report about unique challenges nursing homes on Cape Cod face. He says even with creative solutions like IntelyCare, he’s worried the Cape is in a precarious place.

"The need for skilled nursing services is only going to increase," he said. "And I'm particularly concerned about further closing of nursing homes, especially in the extremities of the region, the Outer Cape and on the Islands – places where we have only one or two nursing homes, and those are particularly under stress."

Earlier this year, state legislation put about 50 million dollars towards helping nursing homes offset their financial strain. But advocates say they’re going to need a lot more money to properly address this challenge. According to the Massachusetts Senior Care Association, nursing homes have a spending deficit of about 360 million dollars annually.